What was the programme theory of New Labour’s health system reforms?

To examine whether the Health System Reforms delivered the promise of being a coherent and mutually supporting reform programme; to identify the underlying programme theory of the reform programme; to reflect on whether lessons have been learned. \ud \ud Documentary analysis mapping the implicit and explicit programme theories about how the reforms intended to achieve its goals and outcomes. Semi-structured interviews with policy-makers to further understand the programme theory. \ud \ud The Health System Reforms assumed a ‘one size fits all’ approach to policy implementation with little recognition that some contexts can be more receptive than others. There was evidence of some policy evolution and rebalancing between the reform streams as policy-makers became aware of some perverse incentives and unforeseen consequences. Later elements aimed to restore balance to the system. \ud \ud The Health System Reforms do not appear to comprise a coherent and mutually supportive set of levers and incentives. They appear unbalanced with the centre of gravity favouring suppliers over commissioners. However, recent reform changes have sought to redress this imbalance to some extent, suggesting that lessons have been learned and policies have been adapted over time

A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists’ (CPs) involvement. Objective To determine CPs’ awareness of and involvement with IC services, perceptions of the transfer of patients’ medication information between healthcare settings and views of the development of a CP–IC service. Setting Community pharmacies in Northern Ireland. Methods A postal questionnaire, informed by previous qualitative work was developed and piloted. Main outcome measure CPs’ awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs ‘agreed/strongly agreed’ that they understood the term ‘intermediate care’. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings ‘all of the time’. Only 9.5 and 0.5 % of respondents ‘strongly agreed’ that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. ‘Current workload’ was ranked as the most important barrier to service development. Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients’ medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11096-016-0377-3) contains supplementary material, which is available to authorized users

Anthracite Outdoor Adventure Area (AOAA) Corridor Analysis

This research investigates the potential economic opportunity that is provided to the Shamokin area because of the creation of Anthracite Outdoor Adventure Area (A.O.A.A.). Using spatial analysis, we illustrate travel to the area, commercial mapping and potential accommodation mapping. The exponential growth of A.O.A.A. that has been seen so far illustrates the necessity to rethink commercial zoning in the future, and although there are plans for hotels and future investors, we argue to maximize economic and social benefit to the Northumberland county area, it is necessary to address those challenges and create short-term solutions to bring as much economic prosperity as possible. The research addresses four core goals: 1. Better understand the A.O.A.A. and how it relates to the surrounding area 2. Visually depict where people are traveling from and how they’re getting to the A.O.A.A. during different times of year 3. Research possible solutions to A.O.A.A. obstacles including: understanding visitor transportation routes, parking alternatives, overnight accommodations, better integration between visitors, Shamokin residents, and the A.O.A.A. and visually depict the expansion of the commercial zone of Shamokin. 4. Create maps and a proposal that A.O.A.A. can share with potential investors and people interested in a summary of this information. This report is the result of a student group project for Geography 326 Thinking Space taught by Prof. Vanessa Massaro. The GIS component of the project was part of work for Geography 204 Applied Geography taught by Prof. Duane Griffin

A constant Chinese Loess Plateau dust source since the late Miocene

© 2019 The Authors The Pliocene-Pleistocene boundary marks a major change in global climate and East Asian monsoon dynamic. However, the role of the global atmospheric dust-cycle over this time is unclear; in particular the degree to which changes in the dust cycle influenced climate change, were driven by climate change, and how these processes interacted. Chinese loess records past dust-cycle history and the influences of aridification and monsoon circulation over the last 40 Ma. Previous work on the Chinese Loess Plateau argue over whether changes in dust source occur at the Pliocene-Pleistocene boundary, or at 1.2 Ma, despite these intervals marking major shifts in monsoon dynamics. We present Sr, Nd and Hf isotope data from multiple sites and show that dust source largely remains unchanged across these boundaries. Shifts in geochemistry are due to changes in grain-size and weathering. While the transport pathway (river, deserts, direct aeolian) is unclear, these tracer isotopes show that dust was dominantly sourced from the Northern Tibetan Plateau, with some input from the local bedrock. This shows that a major established and constant dust source on the Tibetan Plateau has been active and unchanged since late Miocene, despite dramatically changing climate conditions. Changes in loess accumulation are a function of climate change in Tibetan Plateau source regions rather than effects from increased aridification over the Pliocene-Pleistocene boundary

Hepatitis B Virus Prevalence and Mother-to-Child Transmission Risk in an HIV Early Intervention Cohort in KwaZulu-Natal, South Africa

BACKGROUND: HIV and hepatitis B virus (HBV) prevalence are both high in KwaZulu-Natal, South Africa. HIV coinfection negatively affects HBV prognosis and can increase the likelihood of HBV mother-to-child transmission (MTCT). In an early HIV infant treatment intervention cohort of HIV-transmitting mother-child pairs in KwaZulu-Natal, we characterized maternal HBV prevalence and screened infants at risk. METHODS: Infants were treated for HIV MTCT at birth, and combination regimens incidentally active against HBV were initiated within 21 days. Maternal samples (N = 175) were screened at birth for HBV infection (HBV surface antigen [HBsAg]), exposure to HBV (HBV anti-core IgG), and vaccination responses (HBV anti-S positive without other HBV markers). Infants of mothers who were HBV positive were screened for HBsAg at 1 and 12 months. RESULTS: Evidence of HBV infection was present in 8.6% (n = 15) of maternal samples. Biomarkers for HBV exposure were present in 31.4% (n = 55). Evidence of HBV vaccination was uncommon in mothers (8.0%; n = 14). Despite prescription of antiretroviral therapy (ART) active against HBV, HBV DNA was detectable in 46.7% (7/15) of mothers who were HBsAg positive. Three mothers had HBV viral loads >5.3 log10 IU/mL, making them high risk for HBV MTCT. Screening of available infant samples at 1 month (n = 14) revealed no cases of HBV MTCT. At 12 months, we identified 1 HBV infection (1/13), and serologic evidence of vaccination was present in 53.8% (7/13) of infants. DISCUSSION: This vulnerable cohort of HIV-transmitting mothers had a high prevalence of undiagnosed HBV. Early infant ART may have reduced the risk of MTCT in high-risk cases. Current HBV guidelines recommend ART prophylaxis, but these data underline the pressing need to increase availability of birth dose vaccines

The design and application of a 50 K SNP chip for a threatened Aotearoa New Zealand passerine, the hihi

Next-generation sequencing has transformed the fields of ecological and evolutionary genetics by allowing for cost-effective identification of genome-wide variation. Single nucleotide polymorphism (SNP) arrays, or “SNP chips”, enable very large numbers of individuals to be consistently genotyped at a selected set of these identified markers, and also offer the advantage of being able to analyse samples of variable DNA quality. We used reduced representation restriction-aided digest sequencing (RAD-seq) of 31 birds of the threatened hihi (Notiomystis cincta; stitchbird) and low-coverage whole genome sequencing (WGS) of 10 of these birds to develop an Affymetrix 50 K SNP chip. We overcame the limitations of having no hihi reference genome and a low quantity of sequence data by separate and pooled de novo assembly of each of the 10 WGS birds. Reads from all individuals were mapped back to these de novo assemblies to identify SNPs. A subset of RAD-seq and WGS SNPs were selected for inclusion on the chip, prioritising SNPs with the highest quality scores whose flanking sequence uniquely aligned to the zebra finch (Taeniopygia guttata) genome. Of the 58,466 SNPs manufactured on the chip, 72% passed filtering metrics and were polymorphic. By genotyping 1,536 hihi on the array, we found that SNPs detected in multiple assemblies were more likely to successfully genotype, representing a cost-effective approach to identify SNPs for genotyping. Here, we demonstrate the utility of the SNP chip by describing the high rates of linkage disequilibrium in the hihi genome, reflecting the history of population bottlenecks in the species

Fishing for MSY: using “pretty good yield” ranges without impairing recruitment

Pretty good yield (PGY) is a sustainable fish yield corresponding to obtaining no less than a specified large percentage of the maximum sustainable yield (MSY). We investigated 19 European fish stocks to test the hypothesis that the 95% PGY yield range is inherently precautionary with respect to impairing recruitment. An FMSY range was calculated for each stock as the range of fishing mortalities (F) that lead to an average catch of at least 95% of MSY in long-term simulations. Further, a precautionary reference point for each stock (FP.05) was defined as the F resulting in a 5% probability of the spawning-stock biomass falling below an agreed biomass limit below which recruitment is impaired (Blim) in long-term simulations. For the majority of the stocks analysed, the upper bound of the FMSY range exceeded the estimated FP.05. However, larger fish species had higher precautionary limits to fishing mortality, and species with larger asymptotic length were less likely to have FMSY ranges impairing recruitment. Our study shows that fishing at FMSY generally is precautionary with respect to impairing recruitment for highly exploited teleost species in northern European waters, whereas the upper part of the range providing 95% of MSY is not necessarily precautionary for small- and medium-sized teleosts.</jats:p

University for the Creative Arts staff research 2011

This publication brings together a selection of the University’s current research. The contributions foreground areas of research strength including still and moving image research, applied arts and crafts, as well as emerging fields of investigations such as design and architecture. It also maps thematic concerns across disciplinary areas that focus on models and processes of creative practice, value formations and processes of identification through art and artefacts as well as cross-cultural connectivity. Dr. Seymour Roworth-Stoke